Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes



There is a growing awareness that patients should be more active and effective managers of their health and health care. Recent studies have found patient activation—or having the knowledge, skills, and confidence to manage one’s health, to be related to health-related outcomes. These studies have often relied on self-reported outcomes and often have used small samples.


To examine the degree to which patient activation is related to a broad range of patient health and utilization outcomes in a large, insured population.


Cross-sectional study of patients at Fairview Health Services in Minnesota. Data on patient activation and patient outcomes were derived from the electronic health record, abstracted in December 2010.


A total of 25,047 adult patients were included in the analysis. They all had a primary care visit in the prior six months and completed the patient activation measure as part of an office visit.

Main Measures

The key independent measure was the Patient Activation Measure. We examined 13 patient outcomes across four areas: prevention, unhealthy behaviors, clinical indicators, and costly utilization.


In multivariate models, patient activation was related to 12 of 13 patient outcomes in the expected direction. For every additional 10 points in patient activation, the predicted probability of having an ED visit, being obese, or smoking was one percentage point lower. The likelihood of having a breast cancer screen or clinical indicators in the normal range (A1c, HDL, and triglycerides) was one percentage point higher.


This cross sectional study finds that patient activation is strongly related to a broad range of health-related outcomes, which suggests improving activation has great potential. Future work should examine the effectiveness of interventions to support patient activation.

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    The ranges of per capita income in the terciles were $10,618–$22,653, $22,654–$28,606, and $28,607–$69,391. The vast majority (95%) of the patients in the top income tercile lived in zip codes with per capita incomes under $38,583. The results of analyses using quartiles instead of terciles were substantively similar.


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We would like to thank Fairview Health Services for their support of conducting this research study. Specifically, we would like to thank Valerie Overton, Patricia Lutz, and Scott Johnson for their ongoing help, commitment, and good spirits throughout the research process. In addition, we would like to acknowledge the editor’s very helpful comments and recommendations for the paper, as well as those of the three anonymous reviewers. This research was supported by a grant from the Commonwealth Fund. An earlier version of this paper was presented at the 2011 AcademyHealth Conference in Seattle, WA.

Conflicts of Interest

Jessica Greene has no potential conflict of interest to disclose. Judith Hibbard discloses a potential conflict of interest with her ownership stake in and consultancy with Insignia Health LLC.

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Correspondence to Jessica Greene PhD.

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Greene, J., Hibbard, J.H. Why Does Patient Activation Matter? An Examination of the Relationships Between Patient Activation and Health-Related Outcomes. J GEN INTERN MED 27, 520–526 (2012). https://doi.org/10.1007/s11606-011-1931-2

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  • patient activation
  • patient engagement
  • health care quality